Vasospastic angina pectoris – pathogenesis, diagnostics and treatment


Authors: E. Sovová;  J. Lukl;  Č. Číhalík
Authors‘ workplace: I. interní klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Jan Lukl, CSc.
Published in: Vnitř Lék 2005; 51(5): 548-554
Category: Reviews

Overview

In 1959 Prinzmetal described a syndrome of chest pains with typical ST segment elevation on ECG that is due to spasm of large epicardial or septal artery. Currently the term vasospastic angina (VSA) is used more often in literature. VSA can lead in acute myocardial infarction, it can be accompanied with serious cardiac arrhythmias and even sudden death is described in these patients. Pathogenesis of this syndrome is not completely clear. Effect of endothelial dysfunction, inflammatory factors, disorder of coagulation mechanisms, smoking and low level of magnesium belongs among suggested mechanisms of disease. ECG and Holter ECG monitoring is the basic examination of VSA, ergometry is not beneficial. Selective coronarography (SKG) with ventriculography performed during paroxysm proves focal spasm. SKG can be combined with spasm provocation (ergonovine, acetylcholine or hyperventilation). Provocative agent can be used also in combination with other imaging method, such as echocardiography or nuclear methods. The most widespread provocative agent in the world is ergonovine maleate, the test having sensitivity up to 100%. Nitrates and calcium antagonists are used in the treatment. Opinion on the use of beta-blockers and acetylsalicylic acid is not unified. Some authors recommend magnesium, estradiol supplement or vitamin E in the treatment.

Key words:
vasospastic angina – vasospastic angina pathogenesis – examination methods for vasospastic angina – vasospastic angina treatment


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